Introduction

In the established environment of the Clinical Neurosciences Department, enormous quantities of data can be captured from each patient, from which information regarding cerebral autoregulation, cerebrospinal compensatory reserve, oxygenation, and both metabolite production and function can be obtained. Recognition of changing cerebrovascular haemodynamics and oxygenation demands not only reliable monitoring techniques, but also sophisticated and time-consuming signal analysis. This can be provided by dedicated computer support.

The intensive care multimodality monitoring system adopted in the Cambridge Neurosurgical Unit is based on software for the standard IBM- compatible personal computer, equipped with a digital to analogue converter and RS232 serial interface. The first version of the software was introduced into clinical practice in Poland, Denmark, and the U.K. in the mid-1980s and has subsequntly been extended into a system for multimodal neuro-intensive care monitoring (ICM) and waveform analysis of intracranial pressure  (ICP) used in Cambridge, U.K.

Apart from the monitoring of multiple variables  and describing dynamics of the studied pathology, some secondary indices have proven to be useful in clinical neurosciences, describing cerebrospinal compensatory reserve, pressure autoregulation, and vascular reactivity . They have been  demonstrated as useful in describing head injury, poor grade subarachnoid haemorrhage, hydrocephalus, ischemic stroke, experimental laboratory, etc. Extensive description with examples are included in Applications section.

All of these already-documented methodologies are incorporated in the new ICM+ software as pre-defined set-up configurations. On top of this, the performance of the software may be programmed and new forms of analysis may be added by the user. The flexibility of ICM+ software is therefore virtually unlimited.

The minimum hardware requirements for ICM+:

• A modern laptop (or a PC) with Windows 7 or above operating system with a processor supporting SEE2 (or higher) instruction set (eg Pentium Core processors) with standard recommended memory and hard disk for the operating system.
• The laptop should not be in general used to archive the data, so there is no requirement for large hard disks, a standard 512 GB would do nicely.
• For data collection and real time analysis, the memory requirement is also modest and does not require extra space. 2-4GB is standard.
• Touchscreen is recommended for data collection purposes, ideally a 2-in-1 laptop, with keyboard either detachable or flipable so that only the screen can be exposed to touch and cleaning.
• Higher-resolution screens, i.e., at least half HD (1366 x 768) is recommended to accommodate more charts within one screen.
• A Network port and several USB ports available for connecting monitoring devices using Serial-USB adapters.

A Brief History of ICM+

1991 : Professor J.D. Pickard invites all of the group to Cambridge. ICM for DOS is for the first time used on the NCCU in Addenbrooke’s Hospital in 1991 with ten channels, primitive profiling, glue, scissors, and paper needed for displaying long chunks of data.

2004 – Launch of first version of ICM+ software – during ICP12 conference in Hong Kong